Right axillary lymph node metastasis of carcinoma of the cecum with histologically proven cutaneous lymphatic invasion by carcinoma cells: a case report

Abstract

Axillary lymph node metastasis from colorectal carcinoma is extremely rare, and this scarcity hinders understanding of its pathogenesis and, thus, the application of appropriate management. Here, we present a case with axillary lymph node metastasis of cecal carcinoma associated with macroscopic invasion of the skin of the abdominal wall with histological evidence of such invasion, findings which support our hypothesis that the axillary lymph node metastasis developed via the lymph channels in the skin of the abdominal wall. A 76-year-old woman with cecal carcinoma (T4N1M0), complicated with an abdominal wall abscess, underwent right hemicolectomy with partial resection of the abdominal wall. Histology demonstrated multiple sites of lymphatic invasion in the skin. Two months later, an enlarged right axillary lymph node was noticed on CT, and an excisional biopsy was obtained, which later confirmed metastatic adenocarcinoma. This is the first case report of axillary lymph node metastasis of carcinoma of the cecum with histologically proven invasion via the lymphatic system in the skin. If axillary lymph node metastasis results from aberrant lymphatics due to invasion from an adjacent organ, and not the result of systemic malignant disease, it may be considered as a surgically curable pathology. Therefore, the authors advocate that patients with axillary lymph node metastasis should be evaluated with regard to the possibility of surgical curability.

Axillary Lymph Node Metastasis as the First Symptom of Colon Cancer

“…This route is typically seen in cases of colon cancer with abdominal wall invasion. [4][5][6][7] Moreover, colon cancer may metastasize to the breast before spreading to the axillary lymph node. 8 Concurrent metastasis to the right axillary lymph nodes in ascending colon cancer has not been reported previously.…”

Solitary left axillary lymph node metastasis after curative resection of carcinoma at the colostomy site: a case report

“…Colon cancer metastasis to the axillary lymph nodes is rare, especially metastasis to the solitary axillary lymph node. Through our literature search, we identified five cases of colon cancer with ALNM, including only two cases with solitary ALNM [ 2 , 4 – 7 ] (Table 1 ). Metastases to the axillary lymph nodes may develop either lymphatically or hematogenously [ 5 , 7 ].…”

“…Through our literature search, we identified five cases of colon cancer with ALNM, including only two cases with solitary ALNM [ 2 , 4 – 7 ] (Table 1 ). Metastases to the axillary lymph nodes may develop either lymphatically or hematogenously [ 5 , 7 ]. Lymphatic metastasis can proceed through the thoracic duct or via superficial abdominal lymphatic flow.…”

“…Lymphatic metastasis can proceed through the thoracic duct or via superficial abdominal lymphatic flow. Although common colon cancer lymphatic flow travels through the thoracic duct, Kawamura et al demonstrated that the superficial abdominal lymphatic flow is the more important pathway in colon cancer with abdominal wall invasion, as that could lead to development of solitary ALNM [ 7 ]. The superficial lymphatic vessels of the abdominal wall below the umbilicus run downward to drain into the superficial inguinal lymph nodes, while those above the umbilicus run upward to drain into the axillary nodes [ 8 ].…”

“…Thus, we considered that our case with a low malignant potential tumor had a long interval for the recurrence of solitary ALNM. Solitary axillary or inguinal lymph node metastasis of colon cancer can, therefore, be regarded as a local disease, and surgical resection seems to be an effective treatment [ 7 , 12 ].…”